Abstract 04_2023.docx
- 1. April 2023 - Abstract With the increased pressures on Emergency Departments, coupled with the decreasing number of available psychiatric beds in the United States, healthcare workers in both fields find themselves dismayed by the lengthening boarding of patients in acute mental health crisis. Patient in the Emergency Department with primary psychiatric illness with extended ED visits face multiple risks, including miscommunication that results in exacerbation of chronic medical conditions, or delays in medicolegal paperwork that unnecessarily prolong ED stays. We developed a multidisciplinary approach with physicians, nurses and pharmacists to try to reduce the medical errors associated with frequent handoffs without a primary daily hospital team for management. We identified several components of psychiatric care that appeared to be "high miss" areas, including medicolegal status, management of chronic medical conditions and restraint/seclusion orders. We surveyed our department to evaluate specific areas of concern, via email survey and GEMBA analysis. Initial data suggested that most people felt patients were getting all appropriate components of psychiatric care ~30% of the time. We obtained feedback from nursing staff, pharmacy and physicians to establish a checklist to help streamline sign-outs. We developed a mnemonic, "SHEDS" for sugar control, home medications, expiration time for restraints and seclusion, documentation verification, Social Work updates/ Psychiatry consult to identify key aspects of commonly missed yet critical components in the care of our psychiatric patients. We plan to perform post-intervention qualitative surveys and ethnographic data collection to assess for intervention effectiveness.